As the new administration and Congress debate repealing and replacing the Affordable Care Act (ACA), there is intense discussion of how the law actually worked. Obamacare fundamentally changed health care insurance markets, increasing coverage across all demographic groups, altering regulations for the individual health insurance market, and creating state-level electronic marketplaces in which consumers could choose among plans. What worked and what didn’t?

On February 9, the Center for Health Policy at Brookings presented new research and insights derived from fieldwork conducted by the ACA Network, a joint project of Brookings and the Rockefeller Institute of Government. The research focused on the extent and nature of competition in the ACA marketplaces in five large states. Field researchers discussed successes, failures, and needed improvements in market competition in California, Florida, Michigan, North Carolina, and Texas. The presentation was followed by a panel of state-level experts and national leaders in health policy who reacted to the findings and try to answer the question: What comes next?